Millions of people engage in self-destructive behaviors—and they do so for a reason. For them, says psychotherapist Lisa Ferentz, it is a means of coping, because they have not learned more compassionate ways of soothing themselves in times of distress. The way out of the cycle of harm is to learn new ways of short-circuiting untenable thoughts and feelings.
"Reveal the pain" means uncovering, in supportive therapy, the deeper traumatic or painful past experiences that have left you feeling unloveable or worthless and have set you up to mistreat yourself through self-harm.
What are the most significant self-destructive behaviors we engage in?
I try not to support the notion of "more" or "less" serious self-destructive acts. Any act of self-harm including eating disorders, addictions, and all forms of self-mutilation are "significant" when it sustains feelings of guilt and shame, causes distress in relationships, creates defensiveness, secrecy, and lying as well as emotional, physical, or psychological pain.
Are these behaviors idiosyncratic or are there some behaviors that are particularly widespread?
Millions of people—men and women, boys and girls—struggle with a wide range of self-destructive behaviors. One in three girls and one in five boys experience some form of sexual trauma by the time they are 18 years old. Millions of people grow up in families with addiction, which makes physical, sexual, emotional, and verbal trauma, abuse, and neglect much more likely. Such early experiences, along with having parents who are depressed, anxious, or mentally ill, compromise the security of attachment. Children who grow up in such circumstances typically do not learn how to self-soothe in healthy ways. If you don't know how to soothe yourself and got the message that you were unimportant or unlovable, you are set up to engage in self-destructive behavior.
For what not-so-obvious reasons do we engage in behaviors if they are self-destructive?
It's hard to understand that someone would hurt himself in order to "feel better." But in the short term, that's what acts of self-harm accomplish. When the body gets hurt, endorphins get released and the hurt person experiences a euphoric rush. Harming oneself physically is also a way to numb emotional pain and distract attention from emotional pain, overwhelming thoughts, and memories. It's a way to communicate to the world unseen and previously unexpressed suffering that hasn't been healed.
You say that people fight against such behaviors—who does that and why?
Therapists fight against the behaviors by demanding that clients sign standard safety contracts or they make therapy contingent upon the person stopping the behavior. The self-harmer fights against that part of him or herself by feeling guilt, shame, and self-hatred or by attempting to white knuckle abstinence. In both cases, the fight originates in fear and anxiety, the need to be controlling, and the belief that somehow humiliation, coercion, or a power struggle will motivate the person to stop.
What is wrong with fighting against self-harming behaviors?
Therapists set up power struggles that demean and disempower the client and inevitably backfire by causing an increase in the behaviors. The person who self-harms feels increased self-loathing and shame, which sets a person up for further self-harm. When you believe you are worthless, the disregard for your own well-being makes it very easy to do things that harm you. When clients and therapists fight the behavior, then compassion, acceptance, and empathy get lost. Yet these are key ingredients in being able to heal from trauma and eventually let go of self-destructive acts.
What led you to write this book?
I am not a trauma survivor. I know what it means to grow up in a loving, safe family and to care enough about yourself and your body that you would never want to intentionally harm it. I see in my clients the emotional, physical, and psychological pain that self-destructive behavior creates. I see how they hurt themselves because they don’t love or respect themselves. I have made it my life’s work to “pay it forward” by helping others to reconnect with self-compassion and to receive the healing benefits of being in a safe and nurturing therapeutic relationship.
What is the most surprising thing you discovered in researching/writing your book?
I was surprised that almost no one else had looked at the behavior through the same strengths-based, depatholgized lens that I did. The literature still connects self-harm to borderline personality disorder, supports the use of safety contracts, and doesn't put enough emphasis on the role that creative treatment strategies and self-compassion play in the healing process.
What is the most important point you want to get across?
You can't expect people to give up self-destructive behaviors unless they have other ways to accomplish what such acts do for them. People who engage in these behaviors believe they need to do them and get something from them. Sometimes it’s a way to be numb, to self-soothe, to let others know about their pain, or to elicit care-taking responses from loved ones. The behaviors can’t be extinguished until the person is given other strategies that also short-circuit painful feelings, help to soothe and safely reveal the underlying trauma.
Who would most benefit by reading this book?
Any teenager or adult who experiences anorexia, bulimia, bingeing, alcohol or substance abuse, compulsive spending, gambling, is addicted to sexual pornography or the Internet, or engages in any act of self-mutilation in order to self-soothe, distract, numb, or attempt to communicate their pain. Anyone who has a history of trauma, abuse, or neglect would benefit. Anyone who is currently working with a therapist or someone who doesn't have access to mental health resources. The book is equally helpful to professionals as well as family and friends whose loved ones engage in these behaviors.
What is the most profound thing you’ve learned about yourself in writing this book?
It reinforced my capacity to be non-judgmental and hopeful and to hold genuine compassion for people who struggle with self-harm behaviors. That's something I'm proud of, and I think it enables me to be an effective therapist and teacher.
If you had one piece of advice, what would it be and for whom?
This is advice for people who engage in self-harm, their loved ones, and therapists: There is hope and healing for people who hurt themselves! Many people who do these behaviors have done them for years. It’s hard for them to believe they can stop. One of the reasons they may still be struggling is that they have undergone treatment that focused only on the behavior, rather than looked at what’s underneath it. The issue is, has the pain that drives the behavior been addressed? Have they been taught other ways to cope and communicate? Have they worked on learning how to respect and love themselves? I believe that healing begins with an ability to reconnect with self-compassion and kindness. This book and this approach to treatment provide a roadmap to address and work through the deeper issues, and that can feel very hopeful!
What would you like to see happen as a result of your book?
I would love for this book to help reduce shame and increase compassion. It is my hope to depathologize the brave and creative people who engage in self-harm behaviors as a means to cope. I offer readers many creative strategies for self-soothing, communicating pain, and short-circuiting untenable thoughts and feelings in the hope that such techniques will replace their self-destructive acts and render them no longer necessary.
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